NPIMap

Organization Active NPI

St Bernards Physician Clinics, Inc.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Jonesboro, AR
National Provider Identifier
1124813076
Registry record updated Apr 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
Legal business name
ST BERNARDS PHYSICIAN CLINICS, INC.
Practice address
621 E Matthews Ave
Jonesboro, AR 72401-3145
Phone
(870) 932-6799
Fax
(870) 932-8423
NPI assigned
Apr 11, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Lieblong
Title
President
Phone
(870) 932-7024

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YX0905X Primary
AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231H00000X

Addresses

Primary practice location

621 E Matthews Ave
Jonesboro, AR 72401-3145

Mailing address

PO Box 1331
Jonesboro, AR 72403-1331
Phone (870) 932-7024

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210810001875 AR Part B Supplier - Clinic/Group Practice 7012311269 Receives reassigned benefits from 256 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jonesboro, AR; Lake City, AR; Leachville, AR; Manila, AR; Manilla, AR; Marion, AR; Newport, AR; Osceola, AR…

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
St Bernards Physician Clinics Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

225 E Washington Ave
Jonesboro, AR 72401
Phone (870) 207-1630

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744329600000",
    "number": "1124813076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1331",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031331",
            "telephone_number": "870-932-7024",
            "fax_number": "870-930-9377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 E MATTHEWS AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013145",
            "telephone_number": "870-932-6799",
            "fax_number": "870-932-8423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST BERNARDS PHYSICIAN CLINICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-11",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "status": "A",
        "authorized_official_last_name": "LIEBLONG",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "870-932-7024"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.